Image Based Question-66239

Management of 1 week old baby with a condition as shown in the picture below and meconuria is ?

A. Side window colostomy.

B. Dividing the fistula and end colostomy.

C. Diversion colostomy with sleeve resection followed by pull through.

D. Excision of pouch and permanent ileostomy.

Show Answer

Correct Answer » C Explanation

The condition shown in the picture above represents an imperforate anus.

Anorectal malformations (ARM) form the most common group of anomalies dealt by pediatric surgeons all over the world.

Congenital short colon or Congenital pouch colon (CPC)

A varying length of colon is replaced by a large pouch which often opens into genitourinary tract by a fistulous communication associated with anorectal agenesis has been reported mainly from the Indian subcontinent.

Anatomical criteria

1. There is anorectal agenesis.
2. Total length of the colon is short
3. Colon has a pouch formation for a varying length saccular or diverticular with the collection of meconium or faecal matter
4. The blood supply to the pouch is abnormal
5. The colon wall is thick and muscular with hypertrophied mucosa
6. The fistula with the genitourinary tract is large, muscular and long. It is closely adherent with the bladder wall.
7. There is no transitional zone between the pouch colon and the normal bowel. The pattern changes suddenly and sharply.

Clinical features

• Most cases present in the early neonatal period with an absent anal opening and distension of the abdomen with or without meconurea. The association of bilious vomiting with early gross distension of abdomen in a case of anorectal malformation is strongly suggestive.

Management:

The management involves two staged process

1. A diversion colostomy at birth with sleeve resection of colonic pouch.
2. Followed by pull through.